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Annual Scientific Meeting of the Royal Australasian College

Hon Tony Ryall
Minister of Health
18 August 2011

Speech notes prepared for the Annual Scientific Meeting of the Royal Australasian College of Surgeons Queenstown 18 August 2011

Good afternoon. Thank you for inviting me to open the Annual Scientific Meeting of the Royal College of Surgeons here in Queenstown.

First up, thank you for the great work you and your teams have done to produce yet another year of record elective surgery in 2010/11. This has meant more people getting vitally needed surgery faster. More patients than ever before are being treated, sooner.

May I especially acknowledge Mr Ian Civil, President of the College, and Mr Scott Stevenson (the current Chair) and Mr John Kyngdon (the immediate past Chair) of the New Zealand National Board.

May I also welcome your key note speakers: Professor Alan Merry, Chair of the Health Quality and Safety Commission, and Professor Bruce Barraclough, Dean of Education of the College and former Chair of the Australian Council for Quality and Safety in Healthcare.

You have chosen the theme of “Quality and Safety” for this year’s meeting. These are core issues for your membership…and the Government.

Last year, on the recommendation of the Ministerial Review Group, we set up the independent Health Quality and Safety Commission to lead quality and safety improvements in the sector.

The MRG reported evidence of substantial human and financial costs associated with medical errors, and preventable infections.

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According to one study 13% of people admitted to hospital suffer an unintended injury caused by healthcare that resulted in some disability.

The new HQSC will help health professionals across the whole sector improve patient safety and service quality – including public and private, at secondary, primary and community levels.

Real leadership is expected of the Commission in the key areas of infection control, medicine errors and preventing falls.

The key driver of improved patient safety and service quality is clinical leadership.

I welcome the Royal Australasian College of Surgeons taking such a strong interest in this area. I’m confident that there will continue to be a strong working relationship between your organisation and the new Commission.

Investment in Health

This Government is committed to growing and protecting the public health service.

…Despite the challenging global financial situation.

Around the globe, governments are making tough and often unpopular decisions to make ends meet.

And health systems have not been immune from those decisions.

In Britain, many public servants, including doctors and nurses, are facing a two-year wage-freeze.

There are large-scale savings planned within the National Health Service totalling GBP 20 billion. It is estimated 50,000 NHS staff will be made redundant over the next few years.

Already there are reports of cutbacks of almost 1,000 jobs in two London hospitals alone – including significant numbers of nurses and doctors.

In Ireland, the former Health Minister was pelted with red paint by protesters as tempers grew over her Government slashing 5% off the health budget.

The Irish had already cut public service salaries by up to 15%, including doctors, nurses and teachers.

In Canada, the provincial health authorities are now taking tough measures to curb health costs.

Some of these include introducing means testing, halving generic drug prices, and controls on the salaries of top hospital executives and doctors.

Newspapers have reported 2,500 nurses in Ontario are losing their jobs.

Fortunately New Zealand's economy has weathered the storm better than most.

But we’ve been borrowing an average $300 million a week to protect and grow our important social services.

This past year alone the Government's cash borrowing has been around $20 billion.

Health Finances:

And it’s within that context that this year’s Budget makes a remarkable additional $585 million available for health initiatives…the biggest single item and close to half of available funding.

Our commitment to protect and grow the public health service has seen the Government invest $1.5 billion of extra new money into the public health service over the past three years despite the worst economic situation in 80 years.

We’ve been able to maintain and improve key services and infrastructure.

The Budget includes a strong commitment to improving services in a number of key areas: more elective surgery, additional Plunket visits focused on new mums, improvements in maternity safety and quality, more for medicines, higher subsidies for dementia beds, a significant boost for disability services, and $94m more for GP subsidies over 4 years.

The Budget also invests in stamping out rheumatic fever. Eradicating this third world disease from our shores has actually been a health priority since 2001. But nothing ever happened. Except more poor kids got the disease.

A $12 million investment in the budget this year aimed right at this disease will support a massive campaign across high prevalence communities involving school based sore throat clinics for over 22,000 children.

Growing the Health Workforce

Although we are competing with Australian salaries and incomes, we are in the middle of global changes in the medical workforce. Some of those changes may help us, not hurt us.

We have invested another $18 million for an additional 40 medical school places…taking us to 120 of the 200 promised extra places over 5 years.

Once those students graduate, the voluntary bonding scheme we introduced offers them student-loan write-offs in return for working in hard to staff areas or specialties. We’ll soon have over 1700 young doctors nurses and midwives on the scheme.

The Advanced Trainee Fellowship – administered by Health Workforce NZ - assists advanced medical trainees to train or study in a shortage speciality area. Most recipients travel overseas to train. In return trainees are bonded to work in an area of high workforce need or in a hard-to-staff region back in New Zealand.

The global financial crisis has had a marked impact on the workforce across the economy.

Staff vacancy and turnover rates in hospitals, for example, are at an all-time low.

Since November 2008, public hospitals now employ well over 500 extra doctors and well over 1000 extra nurses.

There are more doctors and nurses employed in the public health service than ever before.

But there are still shortages in some specialties and in many rural areas.

We have also sought to focus on retaining our health professionals through providing more opportunities for clinical leadership and research.

At a time when many other countries are reducing their workforces and their investment in health, we have been growing and protecting our health workforce.

Supporting all this is our drive to build a stronger and more productive economy. We’ve taken action across a range of economic issues to improve the economy. For example, lower taxes leave more money in the pockets of hard-working people and the job-creators we are relying on to step-up the economy. Those lower personal taxes have meant an extra $8000 a year for the average hospital specialist.

Health Workforce NZ

Many of you will know of the leadership Professor Des Gorman is providing through Health Workforce New Zealand. Professor Gorman is working with clinicians to answer the challenging question: how does the health service cope with a doubling of demand over the next 10 years within a constrained funding environment? Where is the workforce, and how will it be configured?

Professor Gorman is working actively across the professions to answer that question, and seeks your input. HWNZ does challenge the status quo. Des calls it “disruptive change”! And that thinking is happening on a number of fronts in partnership with the health professions.

For example, Health Workforce New Zealand is demonstrating a Nurse Endoscopy role for New Zealand. In the UK, Nurse Endoscopists contribute to as much as 20% of the workload within a unit – relieving the pressure on waiting times and allowing for earlier diagnoses. At present, endoscopies in New Zealand are done by general surgeons or gastroenterologists. Using Nurse Endoscopists would relieve the pressure on the medical workforce, freeing them up to do other work.

Another example is the postgraduate training programme for Registered Nurse First Surgical Assistants that has started at Auckland University. Thirteen experienced theatre nurses are being trained as surgical assistants between July 2010 and December 2011, with clinical placements at Auckland DHB and several private hospitals around the country. This is another example of nurses extending their scope of practice to ensure we make the best use of the potential of all the healthcare team. And also shows a closer training relationship between public and private.

Another innovation that is being demonstrated at present at Counties Manukau DHB is the role of Physician Assistant. Physician Assistants are an established part of the American health system. They work under the supervision of a senior doctor to take patient histories, conduct physical examinations, develop treatment plans and order lab tests and x-rays. Research has shown they can free up the time of junior doctors and that patient satisfaction with the role is high.

Cardiac Network

In 2009, clinicians established the National Cardiac Surgery Clinical Network to lead and oversee the reform of the New Zealand cardiac surgical system and to improve the delivery of cardiac surgery.

The Network – and its clinical leader Dr Andrew Hamer - has worked with the National Health Board and DHBs throughout New Zealand to achieve a number of significant improvements.

More patients are receiving cardiac surgery and fewer patients are waiting for surgery.

Regional variation in the levels of cardiac surgery is reducing; more patients are receiving coronary artery stents; and the number of patients waiting for their First Specialist Assessment continues to fall.

This progress presents new opportunities to improve the system even more.

For this reason the Cardiac Surgery Clinical Network is being expanded to become the New Zealand Cardiac Network. The new network will oversee and co-ordinate improvements that focus on a full range of cardiac care – not only cardiac surgery.

Improving quality depends on clinical engagement – and it is important that clinicians take the lead in improving health services. This network provides a blueprint for other clinical networks to follow. If we have the privilege of being re-elected in November, then accelerating clinical networks on both a regional and national basis will be a priority.

I need your help

May I conclude on a couple of matters where I need your help.

Fundamental to the New Zealand public health service being able to cope into the future is an increased emphasis on “generalism”…general scopes of practice…general surgery, general orthopaedic surgery. This generalist workforce is the only way our provincial and rural hospitals can thrive into the future.

I talk to many medical graduates considering dual training…general surgery and a sub-specialty. This seems a good thing to me. New Zealand needs general surgeons to maintain their visibility in the public hospital service. I’d appreciate your advice on how we can encourage this further.

And I am also keen to hear from your college about how we can improve systems in order to (a) increase surgical productivity further to further reduce waiting times (b) increase patient satisfaction and the quality of care, and (c) reduce the cost of doing this.


I thank you for the work you are doing in this area. I hope you have a very useful and enjoyable meeting here in Queenstown this year.


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